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General NPI Number Information
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NPI Number | 1932914249
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Entity Type | Individual
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Provider Name | ALEXIS MERCEDES SUTPHIN
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Gender | Female
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 18 S LAKE AVE
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City | ALBANY
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State | NY
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Zip | 12203-1106
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Country | US
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Telephone | 518-436-7972
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Fax |
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Provider Business Mailing Address
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Address Line | 200 RIVERWALK WAY
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City | COHOES
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State | NY
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Zip | 12047-3337
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Country | US
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Telephone | 518-683-5609
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 929169
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License Number State | NY
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